Category: Medicine

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Your arteries know your REAL age

by Fran Johns
1.11.09: CHD, here we come!
Image by Team Dalog via Flickr

Heart attacks, strokes and a long list of other artery-related afflictions top the list of health risks for the 50-and-over population — and a rising number of those even younger. So figuring how old you really are is an increasingly big deal. If your history includes cigarettes and fast food in abundance you might not want to know. But your arteries hold important information.

Wall Street Journal writer Ron Winslow reports on the intricate business of determining your vascular age — and why that’s an important determination to make.

Several tools are available that enable doctors and patients to calculate vascular age. These suggest there can be a substantial difference between how old you are and how old your blood vessels are. For instance, the vascular age of a 35-year-old man who smokes and has diabetes, high blood pressure and abnormal cholesterol could be as high as 76 years old—more than double his chronological age, according to a recent study. The arteries of a 30-year-old woman with similar risk factors could be equivalent to those of an average woman who is more than 80 years old.

Such a calculation “gives a sense that your risk-factor burden is making you age faster than you think you are,” says Donald Lloyd-Jones, a preventive cardiologist at Northwestern University, Chicago, who co-authored the recent study, which appeared in the journal Circulation last August. “The more you can make it concrete, the better you can impart information about risk.”

The good news, doctors say, is that by taking steps to reduce risk factors and the damage they inflict on arteries, it is possible to turn back the clock on vascular age.

Some of us — long-time smokers, members of a family with genetic problems that can’t be overcome — might not be able to access the good news. But many can, and for them, a few changes in lifestyle, or manageable medications, can make a lifetime of difference.

  • A 42-year-old man who smokes and has total cholesterol of 180, good cholesterol (HDL) of 45 and systolic blood pressure of 125, has a vascular age of a 54-year-old. If he quits smoking, his vascular age could drop to 42, the same as his chronological age.
  • A 52-year-old nonsmoking woman, who has total cholesterol of 220, HDL of 44 and systolic blood pressure of 135, has a vascular age of a 68-year-old. If the woman reduces her cholesterol below 200, her vascular age could drop to 59 years old.

If you’re feeling your age today, maybe your arteries are trying to tell you something.

Arteries Can Reveal Your Risk of Heart Disease – WSJ.com.

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A once-a-month alcoholism shot? An anti-cigarette pill? Could happen

by Fran Johns
addiction
Image by alancleaver_2000 via Flickr

For those of us who got off addictions the old-fashioned way, reports from the recent American Psychiatric Association‘s annual meeting sound like good news, even if it’s a little late in coming. AP Medical writer Lauran Neergaard summed up the latest:

“This is the next frontier in substance abuse: Better understanding of how addiction overlaps with other brain diseases is sparking a hunt to see if a treatment for one might also help another.

We’re not talking about attempts just to temporarily block an addict’s high. Today’s goal is to change the underlying brain circuitry that leaves substance abusers prone to relapse.

It’s “a different way of looking at mental illnesses, including substance abuse disorders,” says National Institute on Drug Abuse Director Dr. Nora Volkow, who on Monday urged researchers at the American Psychiatric Association’s annual meeting to get more creative in the quest for brain-changing therapies for addiction.

Rather than a problem in a single brain region, scientists increasingly believe that psychiatric diseases are a result of dysfunctioning circuits spread over multiple regions, leaving them unable to properly communicate and work together. That disrupts, for example, the balance between impulsivity and self-control that plays a crucial role in addiction.

Addiction is a strange phenomenon, and we who know a lot about it (this writer kicked cigarettes in the 60s, alcohol in the 80s, crunching ice — you haven’t ever met an ice-crunching addict? Believe it. — five or six years ago) say it’s about time we got our own dysfunctional circuitry studies.

Think of it as if the brain were an orchestra, its circuits the violins and the piano and the brass section, all smoothly starting and stopping their parts on cue, Volkow told The Associated Press.

“That orchestration is disrupted in psychiatric illness,” she explains. “There’s not a psychiatric disease that owns one particular circuit.”

So NIDA, part of the National Institutes of Health, is calling for more research into treatments that could target circuits involved with cognitive control, better decision-making and resistance to impulses.

Addictive behavior has drawn attention from researchers and writers for years. A 1983 study done for the National Academy of Sciences by Alan R. Lang, Professor of Psychology at Florida State University reported that “some mental health experts find it useful to view addiction as including all self-destructive, compulsive behaviors”  and cited references to addictions as wide-ranging as caffeine (guilty), chocolate (definitely) and gambling (not on your life.)

Changing behaviors to conquer addictions, with a little help from therapies and therapists of all sorts, has been plugging along as a solution for decades. Takes a lot of work. Wouldn’t a magic pill be lovely?

Targeting brain circuits for addiction, relapse.

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Abortion wars: pro-choice forces question accuracy of new poll

by Fran Johns

However the “pro-life” tag for all those anti-women’s-rights people came to be co-opted, it was a stroke of genius. It is, of course, more devious than truthful. Anti-abortion forces, as this space has raged about from time to time, piously support the life of a fertilized egg, while ignoring the lives of mature women. But the loaded label is firmly set.

Most recently, a Gallup poll has brought it to the forefront once more. That poll, released early this month, showed that slightly more Americans call themselves “pro-life” (47%) than “pro-choice” (45%.) The figures are about the same as shown in a similar poll last July, though the pro-life leanings are actually weaker than the percentages a year ago (51% to 42%.) Writer Amanda Marcotte, blogging at RH Reality Check, argues that the poll numbers don’t reflect the political strength of pro-choice Americans. Rather, she says,

the term “pro-life” is more of a tribal identifier or a feel-good term than it is a political stance.  This becomes only clear when you consider that pro-life activists tend to follow the lead of the Vatican (even if they’re Protestant) and object to all forms of fertility control that offer women a reasonable amount of control over their own bodies.

Marcotte interviewed Jessica Grose, whose article on Slate.com about the poll also questioned whether the pro-life numbers reflect a trend against women’s choice, or might be attributable to other factors. Republicans not wanting to be counted as pro-choice because it might align them with Democrats, or Obama; the general movement of Gen Y away from pro-choice. Grose does not, in the long run, see the poll numbers as a voice of doom.

The notion that more and more Americans are embracing the pro-life label is pretty terrifying for pro-choicers. But what does it really mean to call yourself pro-life or pro-choice? Do the labels actually track people’s views about the legality of abortion? The answer may be yes, but not in a simple or neat way. Though more people are calling themselves pro-life, the percentage of Americans who say abortion is morally wrong is down six points from last year. But at the same time, a Pew poll from last August showed that slightly more people are also saying that abortion should be illegal in all circumstances, though the gain is only 1 percent from the previous September.

The upcoming Supreme Court nomination process could potentially shift things back to the pro-choice label. It’s not about Elena Kagan per se, but Gallup senior editor Lydia Saad says that when the abortion issue is raised in relation to the Supreme Court, the issue tends to help the pro-choice side—because, in the end, most people don’t want to overturn Roe v. Wade. Recent data back up the second part—according to a CBS News/New York Times poll from April says that 58 percent of Americans still believe that Roe v. Wade was a good thing.

A hopeless optimist to the core, I wish I could join these wise observers in finding any glimmer of hope in the whole scene. From where I sit and what I know — and I am among the steadily dwindling few who know first hand the horrors that women faced pre-Roe v Wade — the hard core anti-abortionists are pulling every trick in the book to gain ground, and it’s working. If they ultimately do win, women will suffer an unfathomable loss.

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Grief: A mind/body conundrum

by Fran Johns
Physician treating a patient. Red-figure Attic...
Image via Wikipedia

This is a cautionary tale.

The main character, a woman of a certain age, became concerned about suddenly being short of breath. Nine months earlier she had defended her title in a 5k community road race, so it didn’t seem to make sense that she would be huffing and puffing after one block on a slight incline. She worried more and more, and finally went to see her primary care physician.

“No,” said the doctor, “this should not be. We’ll start with a stress test to check out the heart, and then go with a pulmonary function test. Recent x-rays haven’t shown anything wrong with your lungs, but we’ll want to make sure.”

The patient aced the stress test, which relieved everyone. Subsequently, at the end of the pulmonary function tests she did the six-minute walk, as instructed, regular pace, and the nurse who had been following along in case she conked out said, “Well, you’ve got no shortness of breath, and I’m exhausted.”

In between, an interesting thing had happened. During a visit with her niece, who is a family practice physician in another state, the medical dilemma happened to come up. “Well,” said the niece, rather gently, “you’re doing all the right things: seeing your doctor, having a stress test first, checking pulmonary function. But when all is said and done you did just lose a sister to respiratory failure, while you were still grieving the loss of another sister almost within the same year…   It could be that your body is just trying to tell you something.”

Almost immediately I felt better. Went ahead with the pulmonary function test just to err on the side of caution, but by then I was feeling so much better that just walking around that hospital corridor at what felt a leisurely pace was still enough to wear out a nurse who is 10 years younger. She hadn’t told me she was required to follow. And of course, at the start of it all, I hadn’t thought to mention anything about sibling loss to my primary care doctor. Communication is good.

Soon afterwards, I attended a meeting at which the keynote speaker was Lyn Prashant, founder of an organization called Degriefing. Among the handouts was a page headed “Common Grief Reactions,” featuring lists of physical, emotional and mental responses to grief. Number 5 under Physical? You guessed it: shortness of breath.

Who knew? Certainly not this writer, who has only spent the past three decades intensely involved with end-of-life issues. Hospice volunteer, part of an AIDS support group throughout the 1990s, currently a chapter board member and client volunteer for Compassion and Choices, author of dozens of articles and one book about end-of-life issues. Never heard of any of those physical manifestations of grief — or if I had, they were too abstract to register.

That was then, this is now: Loss, sorrow, grief — is it all in your head? Maybe not.

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Alzheimer's: old music, new songs

by Fran Johns

Think nursery rhyme. Sing the words. How long is it since you learned that ditty?

Years ago a friend of mine named Alice suffered a stroke that left her with the ability to say only two words: “one, two.” Or she may have been saying “want to.” In the months ahead she developed a skill for packing more meaning into that phrase than most of us can manage in several paragraphs. “ONE two!,” she would fairly shout at her husband, expressing displeasure (something she did with regularity before the stroke.) “OnetwoONEtwo?” she would ask, in a “Do you really like it?” voice. Still, it was tough on friends and family, and had to have been more than frustrating for her.

Eventually Alice and her husband moved into an assisted living facility. Though she was a woman of limited education and resources, she was able to resume a minimal degree of activity within that community. I saw her about once a week there, for a period of months.

At Christmas time, a group of us went caroling in Alice’s building. Midway through one old, familiar song, as we stood facing an assembled group of residents, someone noticed that Alice was singing merrily along, word for word. There was a lot of nudging and head-nodding, and by the end of the last verse not a dry eye. As we left, Alice smiled and said, “One two, one two.”

Now comes another interesting word about music and the mind, from a Science Daily article posted on the PositScience blog. It cites results from research by the Boston University School of Medicine showing that people with Alzheimer’s retain verbal information better when it comes within the context of music. The findings appear online in Neuropsychologia, an international journal to which I admittedly do not subscribe.

To determine whether music can enhance new learning of information, AD (Alzheimer’s Disease) patients and healthy controls were presented with either the words spoken, or the lyrics sung with full musical accompaniment along with the printed lyrics on a computer screen. The participants were presented visually with the lyrics to 40 songs. Twenty of the song lyrics were accompanied by their corresponding sung recording and 20 were accompanied by their spoken recording.

After each presentation, participants were asked to indicate whether or not they were previously familiar with the song they had just heard. The BUSM researchers found accuracy was greater in the sung condition than in the spoken condition for AD patients but not for healthy older controls.

The blog elicited responses ranging roughly from “that’s very interesting” to “so what else is new?” I come down on the “that’s very interesting” side of the issue, because it is.

And the more we know about connections of this sort, the more we begin to understand about the workings of the mind and the broader the possibilities of unlocking its secrets. Those pesky memorizations of yore, set to music, still manage to survive all manner of afflictions.

I still can’t figure out where I put the keys… but I can sing you every line of “Itsy Bitsy Spider.”

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Brain exercises oversold, study says

by Fran Johns

What? Brain exercises aren’t all they’re cracked up to be? Bah, humbug. But indeed, according to the Wall Street Journal‘s Gautam Naik in a recent article, “a large new study casts doubt on whether such programs can deliver what they promise.”

The hallmark of a good brain-training program isn’t whether it simply improves a person’s ability to do the specific mental tasks in the training, but whether it also boosts other cognitive skills. The latest study, published in the journal Nature, found no evidence for such cognitive transfers.

“Our brain-training groups got better at the tests they practiced, and the more they practiced, the better they got. But there was no translation to any improvements in general cognitive function,” said study co-author Jessica Grahn, a scientist at the Medical and Research Council’s Cognition and Brain Sciences Unit in Cambridge, England. The unit has close links to the University of Cambridge.

Full disclosure: Posit Science CEO Steven Aldrich (quoted below) provided this geezer-driver writer with his company’s DriveSharp program at no charge. Whenever I can snatch some time (unfortunately that is seldom in 30-minute segments) I work on brain-training computer exercises designed to make me a safer driver.  This is anecdotal and unscientific, but I believe it has made a small improvement.

But back to the study.

The brain-training field has been boosted by studies suggesting that even adult brains are “plastic,” and cognitive ability can be improved with the right mental training. Another spur is an aging population, and the hope that cognitive exercises and lifestyle changes may help to forestall brain maladies such as Alzheimer’s disease.

The authors of the Nature study point out that some modest benefits to cognitive abilities have been reported in studies of older people, preschool children and videogame players who outperform nonplayers on some tests of visual attention. But wider empirical support has been lacking, they said.

The six-week online study involved 11,430 healthy participants, all viewers of a BBC television science program. They were first tested for their existing “benchmark” cognitive abilities, and then randomly assigned to one of three groups, each with a different set of tasks.

One group took part in online games aimed at improving skills linked to general intelligence, such as reasoning, problem-solving and planning. A second test group did exercises to boost short-term memory, attention and mathematical and visual-spatial skills—functions typically targeted by commercial brain-training programs. A third “control group” was asked to browse the Internet and seek out answers to general knowledge questions.

The conclusion: Those who did the brain-training exercises improved in the specific tasks that they practiced. However, their improvement was generally no greater than the gains made by the control group surfing the Internet. And none of the groups showed evidence of improvement in cognitive skills that weren’t specifically used in their tasks.

This study may be in, but the jury is still out. Proponents cite other sources and other studies in this still-new field, most aimed at helping the aging population keep up memory function and stave off general decline. And sites maintaining that it’s possible to build new brain cells continue to proliferate. Critics of the new study weighed in:

Some critics said the study’s design was flawed. For example, the participants were asked to do brain workouts for at least 10 minutes a day, three times a day, for six weeks. But that may not have been long enough.

“It’s not brain training,” said Alvaro Fernandez, chief executive officer of SharpBrains. Past studies, he said, indicate that proper cognition transfer “only happens after more than 15 hours of training and where each session lasts at least 30 minutes.”

Steven Aldrich, chief executive of Posit Science of San Francisco, which sells brain-training programs, said the “study overreaches in generalizing that since their methods did not work, all methods would not work.” Mr. Aldrich added that other randomized, peer-reviewed studies have shown that brain training improves some aspects of brain performance.

Given the growing aging population and its accompanying mental struggles, from Where did I leave the keys? to fears of Alzheimer’s, this space endorses all efforts to better the brain cells. I’m still working on my driving and in favor of giving a game a try.

Study Finds Mental Exercise Offers Brain Limited Benefits – WSJ.com.

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Medical marijuana: a boon & a challenge

by Fran Johns

When my sister Mimi found that marijuana could relieve her severe gastrointestinal distress, years ago, one joint after dinner was all it took. Unfortunately we couldn’t keep up the supply. After one foray into the rather scary realm of pot-dealing in a state (Georgia) where we could have wound up in jail very quickly, we decided that not even such clear relief was worth the risk.

Today, at least in California and 14 other states — with the District of Columbia possibly to be added soon — the risk is minimal but the dosage is fuzzy. The conundrum was outlined by writer Lena K. Sun in the San Francisco Chronicle:

On Tuesday, District of Columbia officials gave final approval to a bill establishing a legal medical marijuana program. If Congress signs off, D.C. doctors – like their counterparts in 14 states – will be allowed to add pot to therapies they can recommend to certain patients, who will then eat it, smoke it or vaporize it until they decide they are, well, high enough.

The exact dosage and means of delivery – as well as the sometimes perplexing process of obtaining a drug that remains illegal under federal law – will be left largely up to the patient. Doctors say that upends the way they are used to dispensing medication, giving the straitlaced medical establishment a whiff of the freewheeling world of weed.

Even in states where marijuana is allowed for medical use, doctors cannot write prescriptions because of the drug’s status as an illegal substance. Physicians can only recommend it, and have no control over the quality of the drug their patients acquire.

Because there are no uniform standards for medical marijuana, doctors have to rely on the experience of other doctors and their own judgment. That, they say, can lead to abuse.

California’s “quick-in, quick-out mills” that readily hand out recommendations have proliferated, worrying advocates. The state, the first to legalize medical marijuana 14 years ago, allows for a wider range of conditions, including anxiety.

To guard against abuse, some doctors say they recommend marijuana only after patients exhaust other remedies. Some doctors perform drug tests as part of pre-screenings.

Mimi died over a year ago. Her last decades, like almost all of her adult life, were spent in the State of Georgia, where medical marijuana is still against the law. I know what her required dosage was; legalization and proper oversight would allow doctors to learn dosages that work for their patients. It seems worse than cruel that thousands of other sick and dying citizens continue to be denied the potential relief that legalized medical marijuana could bring.

Dispensing medical pot a challenge for doctors.

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Dementia: stories and sources

by Fran Johns

The post about dementia sufferers and their tendency to wander (May 6) evoked a host of stories about temporarily lost parents, grandparents, friends and relations. Almost everyone, it seems, has such a story — and unfortunately, those who haven’t may collect one or two in the future.  Reader Cathy Jensen sent a poignant tale of a friend who went wandering in his pajamas during the pre-dawn hours, but was found by the garbage collectors and brought home on the back of their truck. And reader Tom McAfee, en route to see his own mom and hopefully jog memories of children and grandchildren with photos, sent a link to a podcast aired on WNYC in March.

An offbeat idea, the WNYC piece explains, turned out to be a good solution for a nursing home in Germany from which residents were wandering off. Administrators created a bus stop in front of the home, complete with bench and a painted sign for a bus that never came. It provided a place where many wanderers could sit and wait until the urge to go back home, or elsewhere, melted away. Might not work everywhere, but it worked in Dusseldorf.

And reader JTMcKay4 sent, in case you missed them in the comments section, links to the Alzheimer’s Association’s “Safe Return” program and to a source for a long list of related documents. State-specific advance directive forms can also be downloaded, free, from the “Caring Connections” site maintained by the National Hospice and Palliative Care Association site, and this space remains committed to the support of the nonprofit Compassion and Choices, from which forms can also be downloaded.

There is no guarantee against winding up in a memory unit. But a little preparation can go a long way toward helping if the time comes.

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